Abortion on demand, legal, but almost inaccessible: Midwife: “Women do not have a positive right to abortion, only access to this procedure”

In Romania, the country with the most underage mothers in the entire European Union, in eight state hospitals out of ten abortions cannot be performed on request. This, although in our country the procedure is legal until the 14th week of pregnancy. Making a comparison, while in France abortion was introduced in the Constitution, here it is regulated in the Penal Code under the chapter “Crimes against the fetus”. Andrada Cilibiu, Filia activist, specialized in sexual and reproductive rights, explained to us what is hidden behind these doctors' refusals and what should be done at the authorities level.

In Romania, women can have an abortion up to 14 weeks of pregnancy. Photo source: archive

In Romania, sex education in schools exists only on paper. In reality, it is practiced in few educational units. It is also one of the reasons why in many areas of the country women do not know what a condom, an IUD or the morning-after pill is, they do not have access to information and do not know their rights. In our country, according to official data, the youngest mothers are only 15 years old. There are, however, certainly girls of an even younger age who cradle babies in their arms instead of dolls. Moreover, according to information published by NGOs and associations that fight for women's rights, in Romania abortion is still practiced at home with huge risks for health and even life.

What are the authorities doing? Too little to none. This is the conclusion of the latest study carried out by the Association of Independent Midwives, which should sound a big alarm: in our country, in the 21st century, women do not have fundamental rights that, in other states, are contained in the Constitution.

Romania, the country of “lawlessness”

The Association of Independent Midwives shows that over 80% of public medical facilities in Romania do not offer abortion services. Moreover, 90% of hospitals and clinics do not even refer women who request termination of pregnancy. According to the research, out of 176 public medical units that have obstetrics-gynecology sections, only seven provide either medical or surgical abortion. No public facility offers both types of abortion. The reason? In Romania there is a legislative gap that leaves room for interpretations on the one hand, on the other hand it allows us to sneak around.

First of all, we do not have an abortion law. In our country, termination of pregnancy is regulated in the Penal Code under the chapter “Crimes against the fetus”. Secondly, there are no clear regulations of what, however, we have. Hospitals therefore enjoy a great deal of freedom of choice. Either they choose not to do pregnancy interruptions, or they perform the procedures as the managers see fit, according to an internal regulation. There are hospitals, for example, where termination of pregnancy is done up to 12, 10 or even 8 weeks, although abortion on demand is allowed up to 14 weeks gestational age. There are also cases where the abortion is performed with total, partial or even no anesthesia, as decided by the management of the medical unit”Andrada Cilibiu explained for “Adevărul”.

Therefore, a woman seeking an abortion should be grateful that she is legally allowed the procedure and happy to find a hospital willing to help her. What can we say about the conditions he has there!

Each hospital practices this autonomy that is provided by the gates of the law. Women do not have a positive right to abortion, but only access to this procedure. We have the right to ask, but the doctors also have the right to refuse us”, Andrada Cilibiu also specified.

In our country, the procedure is not regulated by any national guide”to tell doctors and hospital managers how to terminate a pregnancy, what to observe in this whole process. And the guide we have for medical abortion, which is very good because it is based on the recommendations of the World Health Organization, is not mandatory to follow. It is just a simple recommendation“, says the Filia representative.

Abortion on demand, huge costs

Why is this intervention not desired, even though it is not prohibited? Why do doctors shy away from this procedure? Why has an abortion ended up being legal, but very difficult to access as a medical service?

Doctors refuse due to conscience clauses and religious reasons. Here we see a strong influence of the anti-abortion organizations, an extremely powerful and vocal minority, which succeeds in persuading medical professionals not to practice abortion. Their message reaches medical schools, hospitals and clinics. Then there are NGOs that try to convince women to keep the pregnancy by giving them, however, false information like: you will die, you will never have children again, you will dream of the child every night… this is completely false information from a medical point of view, but of great emotional impact”, confesses representative Filia, who knows, she says, what is actually hidden behind the so-called psychological counseling.

From our experience with women who have gone through this kind of counseling I can tell you that many of them regret having been persuaded. Let's not forget one essential thing: the fight to limit some rights and to limit bodily autonomy is an immoral, unethical fight“, Andrada Cilibiu explains the main reasons why abortion is allowed in Romania, but it is not really possible.

As for the costs of such an intervention, they are not borne by the state. And the price is not low at all. “A medical abortion can cost the public health system up to 800 lei, and the price of a surgical abortion up to 1,500 lei. In the private system it's even more expensive: the costs can exceed 4,500 lei”, the activist said.

The only procedures covered by the national health insurance system are abortions in progress and care for impending abortions. “The best solution would be to settle this money. A full settlement for the vulnerable categories and a partial one for the other women. In 2022, we asked for this in an open letter sent to the Ministry of Health. However, we were told that our request is not justified. The reason? We are very good in the area of ​​prevention and sexual education. But it's a lie!“, continues Andrada Cilibiu. Even more dramatic, however, is the fact that the Romanian state does not settle the termination of pregnancy even in the case of raped women.

What should be done? A prevention campaign and a dialogue between the authorities and civil society, is the opinion of the activist Filia. “Abortion is the last chance to save a woman who does not want pregnancy. The last choice he can make. Until the abortion, you must have access to information, to sexual education, to contraception, to specialists who can guide you. No one has an abortion for pleasure. It's a traumatic experience, an extremely difficult decision, and no woman should ever have to make it. But the decision belongs to them. Just like their body, health and future belong to them“, says the activist.

The situation in Romania, worrying figures

According to the report published by the Association of Independent Midwives, 111 out of 176 public medical units (63.06%) answered that they do not offer this medical abortion service;

7 units (4%) declared that they provide medical abortion up to 9 weeks or surgical abortion up to 14 weeks;

26 units (14.77%) provide pregnancy termination services up to lower limits than those provided in the recommendations of medical guidelines, pharmaceutical leaflets and national legislation;

As for the situation at the national level in the public and private system, 552 out of 959 public and private medical units (57.55%) answered that they do not perform pregnancy terminations;

66 units (6.88%) provide medical abortion up to 9 weeks, or surgical abortion up to 14 weeks, or both types;

142 medical units (14.8%) provide the medical abortion service on demand, but up to small gestational ages (5-7 weeks for medical abortion or 7-10 weeks for surgical abortion), with non-compliance with the provisions of the leaflets, guidelines, they do not provide information on the phone about the deadline by which they provide medical abortion or surgical abortion, or they answer the phone aggressively;

52 medical units (5.42%) provide access to medical abortion up to 8 weeks of pregnancy or surgical abortion up to 13 weeks of pregnancy;